Plan to scrap bun­dled pay­ments will get in­dus­try scru­tiny

The Trump ad­min­is­tra­tion has not been bash­ful about its de­sire to scale back sev­eral ini­tia­tives launched un­der its pre­de­ces­sor. Per­haps the most sig­nif­i­cant ac­tions have been steps to re­verse course on man­dat­ing that providers par­tic­i­pate in var­i­ous al­ter­na­tive-pay­ment pro­grams.

Be­yond loos­en­ing re­quire­ments for physi­cians to con­tend with the Medi­care Access and CHIP Reau­tho­riza­tion Act, CMS of­fi­cials are look­ing to free hospitals and doc­tors from bun­dled-pay­ment ini­tia­tives. The agency in Au­gust pro­posed can­cel­ing manda­tory bun­dled-pay­ment ini­tia­tives for heart at­tacks, by­pass surg­eries and hip and fe­mur frac­tures that were set to be­gin in Jan­uary. In­dus­try groups will be busy this week putting the fi­nal touches on com­ments to the agency, which are due Oct. 16.

Be­yond propos­ing to can­cel the bun­dle pro­grams, the agency wants to cur­tail from 67 to 34 the manda­tory ge­o­graphic ar­eas par­tic­i­pat­ing in the Com­pre­hen­sive Care for Joint Re­place­ment, or CJR, model.

“Stake­hold­ers have asked for more in­put on the de­sign of these mod­els. These changes make this pos­si­ble and give CMS max­i­mum flex­i­bil­ity to test other episode-based mod­els that will bring about in­no­va­tion and pro­vide bet­ter care for Medi­care ben­e­fi­cia­ries,” CMS Ad­min­is­tra­tor Seema Verma said when the pro­posed rule was re­leased in Au­gust.

While in­dus­try groups have gen­er­ally op­posed the manda­tory na­ture of these pro­grams, there wasn’t unan­i­mous sup­port for ax­ing them en­tirely when the pro­posed rule was is­sued. The Amer­i­can Hos­pi­tal As­so­ci­a­tion won­dered what that would mean for mem­bers that have al­ready ded­i­cated re­sources to build­ing out pro­grams to sup­port the bun­dles. But the trade group rep­re­sent­ing safety net hospitals was more sup­port­ive. “This can­cel­la­tion gives CMS an op­por­tu­nity to eval­u­ate cur­rent mod­els and cor­rect for un­in­tended con­se­quences be­fore de­vel­op­ing an­other vol­un­tary or manda­tory demon­stra­tion,” Dr. Bruce Siegel, CEO of Amer­ica’s Es­sen­tial Hospitals, stated in Au­gust.

See p. 16 for a de­tailed look at how some physi­cians and hospitals have thrived un­der bun­dled pay­ments.